JP2023120311A - Area management of tissue sites on articulating joints - Google Patents

Abstract

To provide a dressing for managing an incision and surrounding tissue where edema and swelling may appear after surgery.SOLUTION: A dressing 110 may maximize coverage of an area in articulating joints, such as a knee or elbow, while allowing a substantial range of motion. The dressing may comprise an adhesive border configured to adhere to skin around an articulating joint, a skin-interfacing fabric for minimizing skin inflammation, a foam body for distributing negative pressure and absorbing an exudate and other body fluids, and a thin polymer film cap for sealing the assembly so that negative pressure can be maintained throughout the dressing.SELECTED DRAWING: Figure 4

Description

RELATED APPLICATIONS This invention has the benefit of U.S. Provisional Patent Application No. 62/575,961, filed Oct. 23, 2017, entitled "Area Management of Tissue Sites on Articulating Joints." § 35.119(e) and is incorporated herein by reference for all purposes.

The present invention, as set forth in the appended claims, relates generally to tissue treatment systems, and more particularly, but not exclusively, to area management of incisions and other tissue sites on articulating joints.

Clinical research and practice has shown that reducing pressure proximal to a tissue site can expand and accelerate new tissue growth at the tissue site. The uses of this phenomenon are numerous, but have proven particularly advantageous for treating wounds. Regardless of the etiology of the wound, whether from trauma, surgery, or another cause, proper care of the wound is important to the outcome. Treatment of wounds or other tissue with reduced pressure is sometimes commonly referred to as "negative pressure therapy", e.g. and "local negative pressure". Negative pressure therapy can provide many benefits, including epithelial and subcutaneous transition, improved blood flow, and micro-deformation of tissue at the wound site. Together these benefits can increase granulation tissue and decrease healing time.

While the clinical benefits of negative pressure therapy are well known, improvements in treatment systems, components, and processes can benefit healthcare providers and patients.

New and effective systems, devices, and methods for managing tissue sites in a negative pressure treatment environment are set forth in the appended claims. Exemplary embodiments are also provided to enable those skilled in the art to make and use the claimed subject matter.

For example, such a device may be a dressing for managing incisions and surrounding tissues where edema and swelling may appear after surgery. Dressings may maximize coverage of areas at joints such as knees or elbows while allowing substantial range of motion. In some embodiments, the dressing includes an adhesive interface configured to contact the skin around the joint joint, fabric that bonds to the skin to minimize skin irritation, branching negative pressure, exudation It may include foam to absorb fluids and other bodily fluids, and a thin polymeric film cap to seal the assembly so that negative pressure can be maintained throughout the dressing. In some embodiments, the dressing may have one or more sections that can be cut to customize the size of the dressing. A separate adhesive film can be applied over the cut for sealing.

More generally, a dressing for treating the area around the articular joint includes an attachment device, such as a sealing ring having a treatment hole, a stem, a first arm attached to the stem, and an arm attached to the stem. a manifold including a second arm, a cover positioned above the manifold and coupled to the mounting device around the manifold, and an adhesive on the mounting device configured to bond to the area around the articulation joint. and may include The manifold may be at least partially exposed through the treatment holes.

In some embodiments, a manifold may include a first arm having a greater span than a second arm. The first arm and the second arm may spread away from the stem in some embodiments. The manifold may include surfaces that are biconcave in some embodiments. For example, the stem, first arm, and second arm may define recessed gaps on opposite sides of the manifold.

Another aspect of the dressing includes a first portion configured to be positioned above the joints of the limb and a second portion configured to at least partially wrap around the proximal portion of the limb. and a third portion configured to at least partially wrap around the distal portion of the limb. For example, the first portion may be positioned above the knee. The dressing may have openings or gaps on each side of the first portion between the second and third portions. In some aspects, the second portion and the third portion may have converging edges. In some aspects, the second portion and the third portion may extend away from the middle of the first portion.

An exemplary method of treating the area around the joint joint of a limb includes the steps of applying the dressing such that the stem of the dressing is positioned above the joint joint; wrapping one arm; wrapping a second arm about the distal portion of the limb; fluidly coupling a negative pressure source to the manifold; and applying negative pressure from the negative pressure source. It's okay.

The objects, advantages, and preferred modes of making and using the claimed subject matter can best be understood by referring to the accompanying drawings taken in conjunction with the following detailed description of illustrative embodiments.

FIG. 1 is a functional block diagram of an exemplary embodiment of a treatment system capable of providing negative pressure therapy according to the present invention. 2 is a graph illustrating additional details of an exemplary pressure control mode that may be associated with some embodiments of the therapy system of FIG. 1; 3 is a graph illustrating additional details that may be associated with another exemplary pressure control mode of some embodiments of the treatment system of FIG. 1; 4 is a plan view of a dressing illustrating additional details that may be associated with the exemplary embodiment of the treatment system of FIG. 1; FIG. FIG. 5 is an assembled view of the dressing of FIG. 4 illustrating additional details that may be associated with some examples. FIG. 6 is a plan view of another example dressing illustrating additional details that may be associated with some embodiments. Figure 7 shows the dressing of Figure 4 applied to an articulating joint;

Although the following description of exemplary embodiments will provide information that will enable one of ordinary skill in the art to make and use the subject matter described in the appended claims, there are specific details that are already known in the art. may be omitted. The following detailed description should therefore be considered illustrative and not limiting.

Exemplary embodiments may be described herein with reference to the spatial relationships between various elements or the spatial orientation of various elements depicted in the accompanying drawings. Such relationships or orientations generally correspond to, or assume a frame of reference for, the patient's posture undergoing treatment. However, as those skilled in the art will recognize, this frame of reference is merely a descriptive tool rather than a strict definition.

FIG. 1 is a simplified functional block diagram of an exemplary embodiment of a treatment system 100 capable of providing negative pressure treatment to tissue sites herein.

In this context, the term "tissue site" includes, but is not limited to, tissue on or in tissue including bone tissue, adipose tissue, muscle tissue, nerve tissue, skin tissue, vascular tissue, connective tissue, cartilage, tendon, or ligament. broadly refers to a wound, defect, or other treatment target in Wounds may include, for example, chronic, acute, traumatic, subacute, and suture wounds, inter-thickness burns, ulcers (such as diabetic, pressure ulcers, or venous insufficiency ulcers), tissue debris, and grafts. The term "tissue site" may also refer to any area of tissue that is not necessarily a wound or defect, but instead is an area where it is desirable to add or enhance additional tissue growth. For example, negative pressure may be applied to the tissue site to grow additional tissue that may be harvested and implanted.

Treatment system 100 may include a negative pressure source or supply, such as negative pressure source 105 , a dressing 110 , a fluid container, such as container 115 , and a regulator or controller, such as controller 120 . Additionally, the therapy system 100 may include sensors for measuring operating parameters and providing feedback signals to the controller 120 indicating the operating parameters. As illustrated in FIG. 1, for example, therapy system 100 may include one or more sensors coupled to controller 120 such as first sensor 125 and second sensor 130 . As illustrated in the example of FIG. 1, dressing 110 may include, in some embodiments, tissue interface 135, covering 140, or both, or may consist essentially of tissue interface 135, covering 140, or both. may

Some components of the therapy system 100 may be housed within other components such as sensors, processing equipment, alarm indicators, memory, databases, software, display devices, or user interfaces that further facilitate therapy. , or may be used in conjunction with other components. For example, in some embodiments, the negative pressure source 105 may be combined with the controller 120 and other components within the treatment facility.

In general, the components of treatment system 100 may be directly or indirectly coupled. For example, negative pressure source 105 may be directly coupled to container 115 or indirectly coupled to dressing 110 through container 115 . Bonding may in some circumstances include fluid, mechanical, thermal, electrical, or chemical bonding (such as chemical bonding), or some combination of bonding. For example, the negative pressure source 105 may be electrically coupled to the controller 120 and may be fluidly coupled to one or more distribution components to provide a fluid pathway to the tissue site. Also, in some embodiments, components may be coupled by physical proximity, by integration into a single structure, or by being formed from the same piece of material.

The dispensing component is preferably removable and may be disposable, reusable or renewable. Dressing 110 and container 115 are examples of dispensing components. A fluid conductor is another example of a distribution component. A "fluid conductor" in this context broadly refers to a tube, pipe, hose, conduit, or other structure with one or more lumens or open passages adapted to carry fluid between two ends. include. Typically the tube is an elongated cylindrical structure with some flexibility, but the geometry and stiffness may vary. Additionally, some fluid conductors may be molded into other components or alternatively integrally combined with other components. The dispensing component may also include or be provided with interfaces or fluid ports to facilitate coupling and decoupling to other components. In some embodiments, for example, the dressing interface may facilitate coupling the fluid conductor to the dressing 110 . For example, such a dressing interface is available from KCI, San Antonio, Texas, USA, SENSAT. R. A. C. (trademark) Pad.

A negative pressure supply, such as negative pressure source 105, may be a reservoir of air at negative pressure, or may be, for example, a vacuum pump, a suction pump, a wall suction port available in many medical facilities, or a micropump. , may be a manual or motorized device. "Negative pressure" generally refers to pressure below the local ambient pressure, such as the ambient pressure in the local environment outside of the sealed treatment environment. Also, in many cases, the local ambient pressure may be the atmospheric pressure at which the tissue site is located. Alternatively, the pressure may be lower than the static pressure associated with the tissue at the tissue site. Unless otherwise indicated, pressure values stated herein are gauge pressures. References to increasing negative pressure typically refer to decreasing absolute pressure, while decreasing negative pressure typically refers to increasing absolute pressure. While the amount and nature of the negative pressure applied to the tissue site may vary depending on the treatment requirements, the pressure is generally a low vacuum and is typically -5 mmHg (-667 Pa) to -500 mmHg (-66.7 kPa). is also called a low vacuum. A typical therapeutic range is -50 mmHg (-6.7 kPa) to -300 mmHg (-39.9 kPa).

Container 115 represents a container, canister, pouch, or other storage component that can be used to manage exudate and other fluids drawn from a tissue site. In many environments, rigid containers may be preferable or necessary for collecting, storing and processing fluids. In other circumstances, fluids may be properly handled without rigid storage containers, and reusable containers can reduce waste and costs associated with negative pressure therapy.

A controller, such as controller 120 , may be a microprocessor or computer programmed to operate one or more components of treatment system 100 , such as negative pressure source 105 . In some embodiments, for example, controller 120 may be a microcontroller, which includes a processor core and processor programmed to directly or indirectly control one or more operating parameters of treatment system 100 . It generally includes an integrated circuit containing memory. Operating parameters may include, for example, power applied to negative pressure source 105 , pressure generated by negative pressure source 105 , or pressure delivered to tissue interface 135 . Controller 120 is also preferably configured to receive one or more input signals, such as feedback signals, and programmed to modify one or more operating parameters based on the input signals.

Sensors, such as first sensor 125 and second sensor 130, are generally known in the art as any device operable to detect or measure a physical phenomenon or property that is generally detected or measured. Provides a signal indicative of a phenomenon or property. For example, first sensor 125 and second sensor 130 may be configured to measure one or more operational parameters of treatment system 100 . In some embodiments, the first sensor 125 may be a transducer configured to measure pressure within the pneumatic path and convert the measurement into a signal indicative of the measured pressure. In some embodiments, for example, first sensor 125 may be a piezoresistive strain gauge. A second sensor 130 may optionally measure an operating parameter of the negative pressure source 105 such as voltage or current in some embodiments. Signals from the first sensor 125 and the second sensor 130 are preferably suitable as input signals to the controller 120, although conditioning some of the signals may be suitable in some embodiments. be. For example, the signal may need to be filtered or amplified before the signal can be processed by controller 120 . Typically the signals are electrical signals, but may also be represented in other forms such as optical signals.

Tissue interface 135 can generally be adapted to partially or fully contact a tissue site. Tissue interface 135 may take many forms and may have many sizes, shapes, or thicknesses depending on various factors such as the type of procedure being performed or the nature and size of the tissue site. You may For example, the size and shape of tissue interface 135 may be adapted to the contours of deep, irregularly shaped tissue sites. Moreover, any or all surfaces of the tissue interface 135 may have protrusions or uneven, rough, or jagged contours that can induce strain and stress on the tissue site, which Granulation can be enhanced at the tissue site.

In some embodiments, tissue interface 135 may be a manifold. A "manifold" in this context includes any material or structure that provides multiple pathways adapted to collect or distribute fluid across a tissue site, generally under pressure. For example, the manifold may be adapted to receive negative pressure from a source and distribute the negative pressure through multiple holes across the tissue site, which collects fluid from throughout the tissue site and directs the fluid toward the source. can have the effect of extracting In some embodiments, the fluid pathways may be reversed or secondary fluid pathways may be provided to facilitate delivery of fluid across the tissue site.

In some exemplary embodiments, manifold passages may be interconnected to improve fluid distribution or collection across tissue sites. In some exemplary embodiments, the manifold may be a porous foam material with interconnected cells or pores. For example, open cell foams, porous tissue collections, and other porous materials such as gauze or felt mats generally have pores, edges, and/or walls adapted to form interconnected fluid channels. including. Liquids, gels, and other foams may also contain pores and fluid pathways or may be cured to contain pores and fluid pathways. In some embodiments, the manifold additionally or alternatively includes protrusions that form interconnected fluid pathways. For example, manifolds may be molded to provide surface protrusions that define interconnected fluid pathways.

The average pore size of the foam may vary according to a given therapeutic need. For example, in some embodiments, tissue interface 135 may be a foam with pore sizes in the range of 400-600 microns. The tensile strength of the tissue interface 135 may also vary according to the needs of a given treatment. For example, the tensile strength of the foam may be increased for instillation of topical treatment solutions. In some examples, the tissue interface 135 is a GRANUFOAM™ dressing or a V.I. A. C. It may also be a reticulated polyurethane foam such as found in VERAFLO™ dressings.

Tissue interface 135 may be either hydrophobic or hydrophilic. In one example where tissue interface 135 is hydrophilic, tissue interface 135 may also allow fluid to escape from the tissue site while continuing to distribute negative pressure to the tissue site. The capillary properties of tissue interface 135 may draw fluid from the tissue site by capillary flow or other capillary mechanisms. An example of a hydrophilic foam is V.I. A. C. A polyvinyl alcohol, open-cell foam like WHITEFORM™ dressing. Other hydrophilic foams may include foams made from polyethers. Other foams that may exhibit hydrophilic characteristics include hydrophobic foams that have been treated or coated to provide hydrophilicity.

The tissue interface 135 may further enhance granulation at the tissue site when the pressure within the sealed treatment environment is reduced. For example, any or all surfaces of tissue interface 135 may have uneven, rough, or jagged contours that can induce microstrains and stresses at the tissue site when negative pressure is applied through tissue interface 135. may have

In some embodiments, tissue interface 135 may be constructed from a bioabsorbable material. Suitable bioabsorbable materials may include, without limitation, polymeric blends of polylactic acid (PLA) and polyglycolic acid (PGA). The polymeric blend may also include, without limitation, polycarbonates, polyfumarates, and capralactones. Tissue interface 135 may further serve as a scaffold for new cell growth, or a scaffolding material may be used in conjunction with tissue interface 135 to enhance cell growth. A scaffold is generally a material or structure used to enhance or enhance cell growth or tissue formation, such as a three-dimensional porous structure that provides a template for cell growth. Illustrative examples of scaffolding materials include calcium phosphate, collagen, PLA/PGA, corral hydroxyapatite, carbonate, or treated implantable materials.

In some embodiments, cover 140 may provide a bacterial barrier and protection from physical trauma. The cover 140 may also be constructed from materials that can reduce evaporative losses and provide a fluid tight seal between two components or between two environments, such as between a therapeutic environment and the local external environment. good. For example, the cover 140 may comprise, or be based on, an elastic film or membrane that can provide a sufficient seal to maintain a negative pressure at the tissue site for a given negative pressure source. be targeted. In some exemplary embodiments, cover 140 may be a polymeric drape, such as a polyurethane film that is permeable to water vapor but impermeable to liquids. Cover 140 may have a high moisture vapor transmission rate (MVTR) in some applications. For example, the MVTR may be at least 250 g/m ² every 24 hours (based on ASTM E96/E96M for upright cup measurements) in some embodiments. Such drapes typically have a thickness in the range of 25-50 microns. For permeable materials, the permeability should generally be low enough so that the desired negative pressure can be maintained.

An attachment device may be used to attach the cover 140 to a mounting surface such as an undamaged skin, gasket, or another cover. Attachment devices may take many forms. For example, the attachment device may be a medically acceptable pressure sensitive adhesive configured to bond the cover 140 to the epidermis surrounding the tissue site. In some embodiments, for example, some or all of the cover 140 may be coated with an adhesive, such as an acrylic adhesive, which is 25-65 grams per square meter (g.s.m. .) coating weight. A thicker adhesive or combination of adhesives may be applied in some embodiments to improve sealing and reduce leakage. Other exemplary embodiments of attachment devices may include double-sided tape, glue, hydrocolloids, hydrogels, silicone gels, or organogels.

FIG. 2 is a graph illustrating additional details of exemplary control modes that may be associated with some embodiments of controller 120 . In some embodiments, controller 120 operates such that negative pressure source 105 provides a constant target negative pressure as indicated by lines 205 and 210 for the duration of the procedure or until manually deactivated. may have a continuous pressure mode. Additionally or alternatively, the controller may have an intermittent pressure mode, as illustrated in the example of FIG. In FIG. 2, the x-axis represents time and the y-axis represents the vacuum generated by vacuum source 105 over time. In the example of FIG. 2, the controller 120 can operate the negative pressure source 105 to cycle between the target pressure and atmospheric pressure. For example, the target pressure may have a specified period of time (eg, 5 minutes) as indicated by line 205 followed by a specified period of inactivity (eg, 2 minutes) as indicated by the gap between solid lines 215 and 220. It may be set at a value of 125 mmHg. The cycling can be repeated by activating the negative pressure source 105 as indicated by line 220, which can form a square wave pattern between the target pressure and atmospheric pressure.

In some exemplary embodiments, the increase in negative pressure from atmospheric pressure to target pressure may not be instantaneous. For example, negative pressure source 105 and dressing 110 may have an initial rise time as indicated by dashed line 225 . The initial rise time may vary depending on the type of dressing and treatment device used. For example, the initial rise time for one treatment system may range from about 20-30 mmHg/sec, and for another treatment system may range from about 5-10 mmHg/sec. When the treatment system 100 operates in intermittent mode, the repeated rise time as indicated by solid line 220 may be substantially equal to the initial rise time as indicated by dashed line 225 .

FIG. 3 is a graph illustrating additional details that may be associated with another exemplary pressure control mode in some embodiments of treatment system 100. FIG. In FIG. 3, the x-axis represents time and the y-axis represents the vacuum generated by vacuum source 105 . The target pressure in the example of FIG. 3 can change with time in dynamic pressure mode. For example, the target pressure may vary in the form of a triangular waveform, with rise time 305 set at a rate of +25 mmHg/min and fall time 310 set at -25 mmHg/min, respectively, resulting in a minimum negative pressure of 50-125 mmHg. and the maximum negative pressure. In another embodiment of the treatment system 100, the triangular waveform varies between negative pressures of 25 and 125 mmHg with rise time 305 set at a rate of +30 mmHg/min and fall time 310 set at -30 mmHg/min. good too.

In some embodiments, the controller 120 may control or determine a variable target pressure in dynamic pressure mode, where the variable target pressure may vary between a maximum pressure value and a minimum pressure value, which may be set as an operator directed input of the desired negative pressure range. The variable target pressure may also be processed and controlled by the controller 120, which can vary the target pressure according to predetermined waveforms such as triangular, sinusoidal, or sawtooth waveforms. In some embodiments, the waveform may be set by the operator as a predetermined or time-varying negative pressure desired for treatment.

FIG. 4 is a plan view of an example dressing 110 illustrating additional details that may be associated with some embodiments. In the exemplary embodiment of FIG. 4, the dressing 110 includes features that allow it to cover articulating joints such as the knee while still allowing a large range of motion. For example, the dressing 110 of FIG. 4 includes a manifold 405 having a stem 410, a first arm 415 joined to a first end of stem 410, and a second arm 420 joined to a second end of stem 410. In general.

In some embodiments, manifold 405 may feature a polyhedron or general cylinder. For example, in FIG. 4, manifold 405 may feature a generally cylindrical shape with face 425 and edge 430 . Edge 430 in FIG. 4 connects stem 410 , first arm 415 and second arm 420 . In some embodiments, a portion of edge 430 may be curved and a portion may be straight. In FIG. 4, for example, the first arm 415 is joined in part by a substantially straight first edge 435 and the second arm 420 is joined by a substantially straight second edge 440 . are connected in part by In other embodiments, first arm 415, second arm 420, or both may have undulations at their distal ends.

Stem 410 is configured to be positioned generally above the articular surface. The width of stem 410 may vary for different types of joints and may be limited to minimize joint interference. For example, in some embodiments, stem 410 is configured to be positioned above the patella and may have a width of 2-4 inches. In other examples, a width of 1-3 inches may be suitable for positioning above the olecranon.

As illustrated in the example of FIG. 4, first arm 415 and second arm 420 may extend away from stem 410 . In some examples, surface 425 may be biconcave. More generally, a portion of edge 430 connecting first arm 415 and second arm 420 converge toward stem 410 to define a concave gap adjacent each side of stem 410 . good too. In the example of FIG. 4, the concave gap is curved. In another example, edge 430 may have straight segments that converge toward an apex at stem 410 .

Some embodiments of manifold 405 may additionally feature an axis of symmetry 445 through stem 410 , and each of first arm 415 and second arm 420 feature a span that is generally orthogonal to axis of symmetry 445 . may be In the example of FIG. 4, a first span 450 between tips 455 is a feature of first arm 415 and a second span 460 between tips 465 is a feature of second arm 420 .

In the example of FIG. 4, first span 450 is greater than second span 460 . A suitable ratio of spans of first span 450 to second span 460 may generally be in the range of 1.2 to 3.4. A ratio of 1.2 to 1.6 may be particularly advantageous for some applications. For example, in some embodiments, first span 450 may range from 30 to 65 centimeters and second span 460 may range from 20 to 45 centimeters. In another example, first span 450 may range from 15 to 50 centimeters and second span 460 may range from 8 to 25 centimeters.

In some embodiments, fluid conductor 470 may be coupled to dressing 110 . As illustrated in FIG. 4, fluid conductor 470 may be coupled to first arm 415 . FIG. 4 also illustrates an example dressing interface 475 , which may be used to facilitate fluidly coupling fluid conductor 470 to manifold 405 .

FIG. 5 is an assembled view of dressing 110 of FIG. 4 illustrating additional details that may be associated with some examples. In the example of FIG. 5, cover 140, manifold 405, adhesive ring 505, and attachment device 510 with treatment area aperture 515 are arranged in a stacked relationship. Generally, cover 140, manifold 405, adhesive ring 505, and mounting device 510 of FIG. 5 have similar shapes. Mounting device 510 may be slightly larger than manifold 405 , and adhesive ring 505 may bond the outer perimeter of manifold 405 to the interior of mounting device 510 . Manifold 405 can be exposed through treatment area hole 515 . In some embodiments, an adhesive may be placed on at least a portion of manifold 405 exposed through treatment area holes 515 . For example, portions of first arm 415, second arm 420, or both may have an adhesive coating. In some embodiments, the adhesive may be coated in a pattern and may cover up to 50% of the surface. Dressing 110 may optionally include one or more release liners, such as central release liner 520 , first side release liner 525 , and second side release liner 530 . In some examples, the dressing 110 may have two release liners, each with perforations or holes configured so that the release liner can be separated into smaller pieces for removal. It may have notches. Additionally, some embodiments may also have one or more casting sheet liners 535 .

In some embodiments, attachment device 510 may be a sealing ring. Similar or similar to cover 140, a suitable sealing ring may be, for example, an elastic film or member, which can provide a seal in a therapeutic negative pressure environment. In some exemplary embodiments, attachment device 510 may be a polymeric film, such as a polyurethane film that is permeable to water vapor but impermeable to liquids. Attachment device 510 typically has a thickness in the range of 25-50 microns. For permeable materials, the permeability should generally be low enough so that the desired negative pressure can be maintained. Attachment device 510 may also include a medically acceptable pressure sensitive adhesive. In some embodiments, for example, attachment device 510 may be a polymeric film coated with an adhesive, such as an acrylic adhesive, where the acrylic adhesive is between 25 and 65 grams per square meter (gsm). .) coating weight. A thicker adhesive or combination of adhesives may be applied in some embodiments to improve sealing and reduce leakage. Additionally or alternatively, attachment device 510 may include a hydrocolloid adhesive, which can substantially reduce or prevent dermatitis.

As illustrated in the example of FIG. 5, some embodiments of manifold 405 may have flexible cutouts 540 . Flexible notch 540 may be parallel to axis of symmetry 445, perpendicular to axis of symmetry 445, or both. Additionally or alternatively, one or more flexible cutouts 540 may be oblique to the axis of symmetry 445 . In some embodiments, only stem 410 may have flexible cutouts 540 . In other embodiments, only first arm 415 , second arm 420 , or both may have flexible cutouts 540 .

The thickness of manifold 405 may vary with a given treatment. In some embodiments, manifold 405 or portions of manifold 405 may include felted open cell foam for increased stiffness. Additionally or alternatively, manifold 405 may include foam segments having different densities. For example, stem 410 may comprise open-cell foam having a higher density than first arm 415 and second arm 420, or may consist essentially of open-cell foam having a higher density.

Cover 140 may be larger than manifold 405 as illustrated in the example of FIG. 5 and may have a perimeter configured to attach to mounting device 510 . For example, cover 140 may have flange 545 . When assembled, cover 140 may be positioned above surface 425 and flange 545 may be attached to mounting device 510 about manifold 405 . For example, adhesive may be used to attach flange 545 to attachment device 510 , or flange 545 may be welded, sewn, or stapled to attachment device 510 . Cover 140 also has holes 550 and extension strips 555 in the example of FIG. Holes 550 can provide fluid communication between manifold 405 and dressing interfaces or fluid conductors. Expansion band 555 may include folds, ribs, bellows, or other means to allow cover 140 to expand when desired.

Some embodiments of dressing 110 may additionally include a comfort layer (not shown) coupled to the manifold and at least partially exposed through treatment area holes 515 . The comfort layer may comprise or consist essentially of a material capable of transferring fluids through the comfort layer while substantially reducing or eliminating dermatitis. . Examples of materials that may be suitable may include woven or non-woven fabrics and fenestrated polymeric films.

Center release liner 520 , first side release liner 525 , and second side release liner 530 may cover any adhesive on attachment device 510 . Additionally or alternatively, center release liner 520, first side release liner 525, and second side release liner 530 may provide rigidity to attachment device 510 to facilitate handling and application. good. Additionally or alternatively, casting sheet liner 535 may cover flange 545 to provide rigidity to cover 140 for handling and application.

FIG. 6 is a plan view of another example dressing 110 illustrating additional details that may be associated with some embodiments. Dressing 110 of FIG. 6 is similar in many respects to dressing 110 of FIG. For example, surface 425 of dressing 110 in FIG. 6 may be biconcave. More generally, a portion of edge 430 connecting first arm 415 and second arm 420 converge toward stem 410 to define a concave gap adjacent each side of stem 410 . good too.

Manifold 405 may additionally feature an axis of symmetry 605 through stem 410 , and each of first arm 415 and second arm 420 may feature a span generally parallel to axis of symmetry 605 . In the example of FIG. 6, first span 450 and second span 460 are substantially equal. Stem 410 in the example of FIG. 6 is offset from the center of first span 450 and second span 460 . Accordingly, first arm 415 and second arm 420 each have a sacrificial extension 610 on one side of stem 410 .

In some embodiments, manifold 405 may have unique pressure zones. For example, stem 410 may be fluidly isolated from first arm 415, second arm 420, or both. Each pressure zone may have a unique fluid interface in some embodiments.

Cover 140, manifold 405, attachment device 510, or various combinations may be assembled prior to application or in situ. In some embodiments, dressing 110 may be provided as a single piece of equipment.

During use, central release liner 520 may be removed from dressing 110 , exposing a portion of attachment device 510 . Manifold 405 may be placed within, above, against, or alternatively proximal to the tissue site, with the exposed portion of attachment device 510 covering the epidermis adjacent to the tissue site. may be attached to the For example, if the tissue site is an incision, manifold 405 may be placed above the incision. In some embodiments, the axis of symmetry 445 may be aligned with some or all of the incisions. If the tissue site is on a limb, the first arm 415 may be wrapped around the proximal portion of the limb and the second arm 420 may be wrapped around the distal portion of the limb. First arm 415 and second arm 420 may not directly contact the incision in some applications, and a stronger adhesive may adhere first arm 415 and second arm 415 to the epidermis adjacent to the incision. may be used to secure at least a portion of the arm 420 of the First side release liner 525 and second side release liner 530 may be removed or applied to additional epidermis adjacent the tissue site. Dressing 110 can thus provide a sealed treatment environment, substantially isolated from the external environment, proximal to the tissue site, with negative pressure source 105 fluidly coupled to manifold 405 through holes 550 . be able to.

FIG. 7 illustrates the dressing 110 of FIG. 4 applied to an incision (not shown) over a joint joint. In the example of FIG. 7, the articulation joint is knee 705 . Stem 410 may substantially cover the top of knee 705, as illustrated in the example of FIG. Manifold 405 is preferably oriented such that first arm 415 and fluid conductor 470 are higher than knee 705 . The first arm 415 may wrap around a portion of the leg above the knee 705 and the second arm 420 may wrap around a portion of the leg below the knee 705 . In some embodiments, one or more of first arm 415 and second arm 420 may be severed to reduce first span 450, second span 460, or both. For example, in the dressing 110 of FIG. 6, the first arm 415, the second arm 420, or both extensions 610 may be arranged such that the first arm 415 and the second arm 420 are higher and lower than the knee 705, respectively. may be cut so as to completely enclose a portion of the

When activated, the negative pressure source 105 can reduce the pressure within the sealed treatment environment. Negative pressure applied across the tissue site through manifold 405 within the sealed treatment environment can induce macro- and micro-strains within the tissue site, further removing exudate and other fluids from the tissue site. can also be collected in container 115 .

Hydraulic mechanisms that use a negative pressure source to reduce pressure in another component or location such as in a sealed treatment environment can be mathematically complex. However, the basic principles of fluid mechanics applicable to negative pressure therapy are generally well known to those skilled in the art, and steps of reducing pressure are referred to herein as, for example, "delivering", "distributing" or "generating" negative pressure. It may be described as an example in the book.

Exudate and other fluids generally flow toward lower pressures along the fluid path. The term "downstream" thus suggests those in the fluid path that are typically relatively close to the source of negative pressure or further from the source of positive pressure. Conversely, the term "upstream" suggests something relatively far from the source of negative pressure or closer to the source of positive pressure. Similarly, the term is sometimes convenient to describe certain features with respect to fluid "inlets" or "outlets" in such frames of reference. This orientation is generally assumed herein to describe various features and components. However, the fluid paths may also be reversed in some applications (such as by using a positive pressure source instead of a negative pressure source) and this description convention should not be considered a limiting convention.

In some embodiments, controller 120 may receive and process data from one or more sensors, such as first sensor 125 . Controller 120 may also control operation of one or more components of treatment system 100 to manage the pressure delivered to tissue interface 135 . In some embodiments, controller 120 may include an input for receiving a desired target pressure and is programmed to process data relating to setting and inputting the target pressure applied to tissue interface 135. may be In some exemplary embodiments, the target pressure may be a fixed pressure value set by the operator as the desired target negative pressure for treatment at the tissue site and then provided as an input to controller 120 . The target pressure may vary from tissue site to tissue site based on the type of tissue forming the tissue site, the type of injury or wound (if any), the patient's health status, and the preferences of the attending physician. After selecting the desired target pressure, controller 120 can operate negative pressure source 105 in one or more control modes based on the target pressure, one to maintain the target pressure at tissue interface 135 . Or it may receive feedback from multiple sensors. In some embodiments, manifold 405 may have unique pressure zones, and different target pressures and control modes may be applied to different pressure zones.

The systems, devices, and methods described herein can provide significant advantages. For example, in addition to the benefits of increasing granulation tissue development and reducing incision healing time, system 100 can also reduce edema and bruising in border areas adjacent to the incision. The dressing 110 can reduce stress on the incision and maximize the coverage area of the joint while still maintaining range of motion. The dressing 110 can also advantageously manage edema and bruising at tissue sites without incisions or open wounds, such as sprains. In some embodiments, the features of dressing 110 may allow treatment of one area for up to 14 days without changing dressing 110 .

Although shown in several exemplary embodiments, those skilled in the art will appreciate that the systems, apparatus, and methods described herein will embrace various changes and modifications that fall within the scope of the appended claims. you will recognize what you can do. Moreover, various alternative statements using terms such as "or" do not require mutual exclusivity unless the context clearly requires it, and the indefinite articles "a" or "an" do not require mutual exclusivity unless the context clearly requires it. Do not limit the subject to a single example unless otherwise specified. Components may also be combined in various configurations or removed for sale, manufacture, assembly, or use. For example, in some configurations, dressing 110, container 115, or both may be removed or separated from other components for manufacture or sale. In still other exemplary configurations, controller 120 may also be manufactured, configured, assembled, or sold independently of other components.

While the following claims recite novel and inventive aspects of the above-described subject matter, the claims may also encompass additional subject matter not specifically recited in detail. be. For example, a particular feature, element, or aspect may be omitted from a claim if it is not necessary to distinguish the novel and inventive feature from features already known to those skilled in the art. Features, elements, and aspects described in connection with some embodiments may also be omitted, equivalents omitted, or omitted without departing from the scope of the invention as defined by the appended claims. may be combined with, or replaced by, alternative features serving a similar or similar purpose.

Claims (33)

In a dressing for treating areas around articular joints with negative pressure,
an attachment device having a treatment hole;
a manifold including a stem, a first arm joined to the stem, and a second arm joined to the stem, wherein the manifold is at least partially exposed through the treatment hole;
a cover positioned above the manifold and coupled to the mounting device around the manifold;
and an adhesive on the attachment device configured to adhere to the area around the articulation joint. 2. A dressing according to claim 1, wherein said first arm has a greater span than said second arm. In the dressing according to claim 1,
the first arm has a first span;
the second arm has a second span;
A dressing, wherein the ratio of said first span to said second span is in the range of 1.2 to 3.4. In the dressing according to claim 1,
the first arm has a first span;
the second arm has a second span;
A dressing, wherein the ratio of said first span to said second span is in the range 1.2 to 1.6. 2. The dressing of claim 1, wherein said first arm and said second arm extend away from said stem. 2. A dressing according to claim 1, wherein said first arm and said second arm include coated edges. 2. The dressing of claim 1, wherein said stem, said first arm and said second arm define biconcave edges. 2. The dressing of claim 1, wherein said manifold includes surfaces that are biconcave. 2. The dressing of claim 1, wherein said manifold has an axis of symmetry through said stem. In the dressing according to claim 1,
said manifold having an axis of symmetry through said stem;
A dressing, wherein said first arm and said second arm define a gap adjacent each side of said stem. In the dressing according to claim 1,
the manifold has an edge connecting the first arm and the second arm;
A dressing, wherein portions of said edges connecting said first arm and said second arm converge toward said stem to define a concave gap adjacent each side of said stem. 2. The dressing of claim 1, wherein said stem includes flexible notches. 2. The dressing of claim 1, wherein said first arm and said second arm include flexible notches. 2. The dressing of claim 1, further comprising a dressing interface fluidly coupled through said cover to said first arm. 2. A dressing according to claim 1, wherein said manifold comprises foam. 2. The dressing of claim 1, further comprising a comfort layer coupled to said manifold, said comfort layer being at least partially exposed through said treatment apertures. In the dressing according to claim 1,
said first arm and said second arm comprising a first foam;
the stem includes a second foam;
A dressing, wherein said first foam has a different density than said second foam. 2. The dressing of claim 1, wherein said stem is fluidly isolated from at least one of said first arm and said second arm. 2. Dressing according to claim 1, characterized in that the adhesive is arranged at the border of the attachment device. 2. A dressing according to claim 1, wherein the adhesive covers at least part of the opposing attachment devices of the first and second arms. 2. A dressing according to claim 1, wherein the adhesive covers about 50% of the opposing attachment devices of the first and second arms. In a method of treating edema around a joint of a limb, comprising:
applying the dressing of claim 1 such that the stem is positioned above the articulation joint;
wrapping the first arm about the proximal portion of the limb;
wrapping the second arm about a distal portion of the limb;
fluidly coupling a negative pressure source to the manifold;
applying negative pressure from the negative pressure source;
A method comprising: In a dressing for treating an area of tissue with negative pressure,
a sealing ring having a treatment hole;
a cover having a perimeter coupled to the sealing ring;
a manifold disposed between the sealing ring and the cover and at least partially exposed through the treatment hole;
The manifold is
a first portion configured for placement above the articular surface of the limb;
a second portion configured to wrap at least partially about the proximal portion of the limb;
and a third portion configured to wrap at least partially about the distal portion of the limb. 24. A dressing according to claim 23, wherein said second portion and said third portion extend away from said first portion. 24. A dressing according to claim 23, wherein said second portion and said third portion comprise converging edges. 24. The dressing of claim 23, wherein said first portion, said second portion and said third portion define biconcave edges. In a method of treating edema around a joint of a limb, comprising:
applying the dressing of claim 23 such that the first portion of the manifold is positioned above the articulation joint;
wrapping the second portion about the proximal portion of the limb;
wrapping the third portion about a distal portion of the limb;
fluidly coupling a negative pressure source to the manifold;
applying a negative pressure from the negative pressure source;
A method, wherein the dressing is capable of articulating the articulation joint. 28. The method of claim 27, wherein said articulation joint is a knee. 28. The method of claim 27, wherein said articulation joint is an elbow. In a dressing for treating an area with an incision over a joint joint comprising:
an attachment device having a treatment hole;
a manifold having a first portion configured to cover the incision and a second portion configured to cover the area around the articulation joint;
a cover positioned above the manifold and coupled to the mounting device around the manifold;
A dressing, wherein the manifold is at least partially exposed through the treatment aperture. 31. The dressing of claim 30, wherein said manifold is a general cylinder having a biconcave surface. 32. The dressing of claim 31, wherein said biconcave surfaces have contoured tips. The system, apparatus, and method substantially as herein described.

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